Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00730
.
ik DEVELOPMENT SERVICES DATE ISSUED:' 12/18/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S101 AC -01300
SITE ADDRESS: 07105 SW HAMPTON ST
SUBDIVISION: BEVELAND NO. 2 ZONING: MUE
BLOCK: LOT : 018 JURISDICTION: TIG
Project Description: Install 2 branch circuits for computer work stations.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL /PANEL:
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 1 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
KAISER FOUNDATION HEALTH OREGON ELECTRIC CONST /GROUP
PLAN OF THE NORTHWEST #838 1010 SE 11TH AVE
ATTN: PROPERTY ACCOUNTING PORTLAND, OR 97214
PORTLAND, OR 97227
Phone: Phone: 503 - 234 -9900
Reg #: LIC 203
SUP 4460S
FEES ELE 26 -95C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 12/18/03 $53.50
[TAX] 8% State Surcharge 12/18/03 $4 Rough -
Elect'I Final
Total $57.78
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -6699 or 1.800 -3 2344.
414 Issued By: � ��— �G'Ll�. if. Permit Signature: Off') or
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO: 1-- /(95
Call 639 -4175 by 7:00pm for an inspection the next business day
DEC -17 -03 03:47PM FROM - Oregon Electric Estimating 5032313587 T -668 P.001 /002 F -530
I / - ' ' -
I�:3I erniit_App l icaExoant OFFICE USE ONLY
ii I�'IU..tliVLJ
. ; City of T Date received: /e2 /y 0 Permit no.: ELL_2- 003— cx�;30
13125 SW Hall Blvd Project/appl, no.: Expire date:
1,� , ' Phone: (503) 6 -4171, FAX: (50 3 ) ,59 1- 1 9 80200 3 Date issued: By: 8. 'Receipt no.:
Internet addres -: www.ci.tigard_or_us Case file no: Payment type:
. 24 -Hour ins • ectlon Re • uest 503 - 639 -4175
Is 152 family dwelling or accesscy " CdM efdiallindu'strial Multi - family ❑ Tenant Improvement
❑ New construction 1 Bt. DCaeditanaitefatiffireGlacement ❑ other. ❑ partial
' JOB SiTE INFORMATION
Job Address: 7106 SW Hampton Bldg. No.: Tax map /tax lot/account no.:
Lot: Blocky Subdivision
Project Name: Kaiser Tigard Dental Description and location of work on premises: circuits for (8) computer work Stations
Estimated Date of completion/irispection:
Will ou call for ins•ection within 24 hours? Yes ❑ No O Pro'ect Contact Ron Collins (503 331 -7005 Phone
CONTRACTOR APPLICATION FEE SCHEDULE
1 'Dunn.
Job No.: 19705 De5criptOn 05, Fee lea.) Total imp
New residetruarsrngfe
J multi- family per dwelling
Business name: Oregon Electnc Group unit. Includes attached
il garage. Service Included:
Address: 1010 SE 'filth Ave. woo sq.ftorlees (; 145,15 $ .
Ci ty: Porband)State: OR Zip: 97214 Ea Add! 500 SF or Portion 5 33.40 $ - 1
Phone: (503) 234 -9900 Fax: (503) 234 -1001 E -mail: Limited Eno ..1 & 2 Family $ 75.00 $ - 2
II
CCB no.; 203 Elec. bus. lio. no.: 26 -950 Umltec Energy, Multi - Family $ 75.00 $ - 2
Citylme Ile 1
Each manufactured home or
i , modular dwttlling, Soryioo
Srgmru.. oi., n J' • „ Qat� 2/17/2003 and/or feeder. 5 90.90 $ - 2
r Service Or Feeders •
Su.. Elect. Name :( t :M rk Wynne , ense no: 4460S Instaliatlon, Alteration or
Relocation;
PROPERTY OWNER 200 amps or less $ 80.30 $ - - 2
Name (glint): 2olamp 400amps 5 10s,a5 $ - 2
Mailing Address: 1 401amps- 600amps $ 160.60 $ - 2
City Stater !Zip: eolompo • 1000amps S 240.60 $ 2
Phone; Fax: IE -mail Over 1000AorVolts $ 464,95 $ - 2
I
Owner Installation: The Installation is being made on property I own which is Raconnact Only $ 66.65 $ 1
not intended for sale, lease, rent, or exchange according to ORS 447, 455, Tempo se p er
Feed - Inatalla0on
479, 670, 701. i.
Alteration or Relocation:
Owner's signature: Date; 200 amps or less 5 66.85 $ • 2
- • ENGINEER 201ampa- 400amps $ 100.50 $ - 2
Name: a Over 401amys • 600amps 5 133.75 $ - 2
Branch Circuits • New.
Address: Alteration or Extension Per
Panel_ A. Fee for branch
City: State; Zip: circuits with purchase of service
or feeder fee, each branch
Phone: Fax: ri E - mail: circuit 5 6.65 $ - 2
B. Fee for branch circuits
WlOut Purchase of Survico or
Feeder. 181 Branch Ckt 1 $ 46,85 $ 46.85 2
❑ Service over 225 amps -corn 11 ❑ Health -care facility Each additional branch circuit 1 $ 6.65 $ 6.65
❑ Service over 320 amps - rating 61 ❑ Hazardous location Miscellaneous • (service or
= feeder not included)
1 &2 family dwellings i ❑ Building over 10,000 square feet four or Each pump or irrigation circle 5 63.40 $ - 2
0 System over 600 volts nomirial more residential units In one structure Each ston or ouuine U91111119 5 53.40 $ - 2
O Building over three stories @ Q Feeders, 400 amps or more Slonal Clrcultla) or Limited Energy
Panel Alteration or Extension"
0 Occupant load over 99 person 0 Manufactured structures or RV park s 7s.00 - $ - -
O Egress /lighting plan 0 Other:
•peacnpucn:
Submit 2 sets of plans with any of the above.
The above are not appli to temporary construction service. _ Each Adah /onai inspection over
the Allowable In any of the
r Notice: This permit eppllcadon Above. Per Inspection
expires if a pandit is not _ 5 62.50 $ -
9 days inve foe:
i oktalnod within 160 da s afterlt
A hes been eeeopred Cx `OUler
I complete. $58.50
Permit Fee
Plan review 25% 50.00
P. State Surcharge 8% $4.28 %'
1 Total $57.78
!l
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line:~, (503) 639 -4171
• BUP
Received Date Requested < AM PM BUP
Location 7/0 5 1pi 1� Suite MEC
Contact Person Ph ( 3 )) 6e) - PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner /6115 ELC .2006-3 — d73)
Footing
ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear NEW
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall Dd' �n g� F741
Fire Sprinkler
Fire Alarm ( t
Susp'd Ceiling („.."
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
PART FAIL
111 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
0 Please call for reinspection RE: ❑ Unable to inspect = no access
Fire ADASupply Line _ l L I d - /� w ,� ✓ _
Approach /Sidewalk Date l !
Inspector L Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL